The following article appeared in our 2014 Annual Report.
As many community hospitals find themselves contracting—or even closing—because of external pressures, Gifford is developing models that will expand services to respond to community needs.
“FQHC resources allow us to expand existing medical services and to create new paths to help patients with behavioral health and dental issues,” says Dr. Martin Johns, medical director of the hospital and medicine divisions. “These areas can impact a patient’s general health, and need to be part of standard primary care.”
Integrating behavioral and dental health into primary care
A special behavioral care team (a psychiatrist, psychologists, social workers, and care managers) has been created to help link access to behavioral health services to primary care. This group will work directly in concert with primary care providers in their offices, so services can be seamlessly added to a patient’s care plan as needed. The new enhanced behavioral health services model will be offered at Gifford’s Randolph campus early in 2015, and will then expand to the community clinics.
Gifford has established relationships with local dentists so that people coming to primary care providers with unmet dental conditions can receive care. This program will hopefully expand to include additional dental providers and other FQHC and federal programs services.
Rising to the challenge of increased substance abuse
Medical centers across the country are struggling to meet the needs of people with alcohol and substance dependency problems. FQHC funding is allowing Gifford to expand existing Vermont Blueprint for Health services so providers can better address the special needs of those who are opiate dependent and want to avoid substance abuse.
Oral exams, medical screenings, and wellness and health access resources
No insurance, high deductibles, or lack of a primary care provider keeps many from getting medical care until they find themselves in an emergency room with a serious problem.
Gifford Health Care in Randolph is sponsoring a free Dental and Medical Health Access Day on Thursday, June 11, 2015 from 8 a.m. to 4 p.m., with free medical and dental health screenings and information about community resources that can help with access to care.
We know that regular primary care can help people manage many chronic conditions, and that dealing with health issues before they become serious can prevent expensive hospital visits. Research has linked gum disease and poor dental health to increased rates of heart disease, premature birth and low birth weights, osteoporosis, and other health problems.
On Dental and Medical Health Access Day, two local dentists (Dr. John Lansky and Dr. Chris Wilson) will give free oral exams, and Gifford primary care providers and pediatricians will provide free health screenings for registered participants. (Call 728-2781 to schedule an appointment.)
A day-long wellness fair, open to the general public, will offer information on preventative health programs and resources to help with access to medical and dental care, including:
Diabetes and diet
Vermont Blueprint for Health
Healthier Living Workshops
Other community resources
Refreshments will be served, and there will be a raffle for registered participants.
For more information, or to register for a free medical screening and oral exam, call Casey Booth at 802-728-2781.
This article was featured in ourSpring 2014 Update Community Newsletter.
The Kingwood Health Center in Randolph underwent an expansion in the fall that both improved the Route 66 health center and freed up needed space at Gifford’s downtown campus.
The addition was completed in November and over the winter several Gifford departments made the move to the impressive, new space. Those departments included:
Occupational and speech therapies, which joined outpatient physical therapy on the ground floor of Kingwood
The move of occupational and speech therapies creates a full-spectrum, multidisciplinary rehabilitation center at Kingwood. Added is some gym space, six new exam rooms and improved staff areas.
“Everyone loves the new building,” notes Megan Sault, the rehabilitation department’s operations coordinator.
Having all rehabilitation services in one, convenient location has reduced confusion among patients as to where they should go for their appointment and allows for a collaborative approach to care.
“It’s really great to be so close to team members and share this beautiful facility,” says speech therapist Kathy Carver, who on the day we visited was meeting with patient Terry White of Randolph Center. Terry, who had a stroke, had also seen physical therapy that day, allowing him to make just one trip to Kingwood, and allowing collaboration on Terry’s care.
For others the new location near Interstate 89 is just convenient.
Occupational therapy patient Michael Dempsey of Brookfield was recovering from a broken arm that had left him with shoulder pain. “It’s nice, got a lot of room and is closer to my house. It’s convenient,” Michael remarked.
On the top floor is new office space for accounting as well as billing, or what the medical center calls patient financial services. This is where patients can go to pay their bills or make billing inquiries.
To find the billing office, park in the upper drive and use the door on the left. There are signs inside.
Gifford first bought the Kingwood building in 2007 as an opportunity to expand services. Initially the flat-roofed, dark structure underwent renovations. The new addition seamlessly expanded the structure toward the wood-line.
Also located at the health center are Gifford’s Blueprint Community Health Team, mental health practitioner Cory Gould, the Diabetes Clinic and a private practice dentist, Dr. John Westbrook – all on the top floor.
Call the health center at 728-7100 and listen for options for reaching the various departments.
Health Connections caseworker Michele Packard remains at the main medical center. Michele provides patients help accessing insurance and free care options. (Go in the main entrance at Gifford’s main campus and look for signs to find Michele.)
Gifford Medical Center in Randolph has been named among the nation’s top 100 performing Critical Access Hospitals by iVantage Health Analytics.
iVantage has developed what it calls a Hospital Strength INDEX and for 2014 measured 1,246 Critical Access Hospitals across the nation on 66 different performance metrics, including quality, patient outcomes and satisfaction, affordability, population health and hospital financial strength.
After weighing all of those factors, Gifford for 2014 has been named among the Top 100 Critical Access Hospitals in the nation – meaning it does well in a variety of areas as compared to its peers.
“Rural health care …. plays a vital role for communities across America, serving nearly 80 million people. The services provided in rural America are similar to those needed in any major metropolitan area, yet the volumes and economic resources provide little economies of scale, making for little benefit from scale. These Top 100 Critical Access Hospitals exhibit a focused concern for their community benefits and needs, regardless of scale, reimbursement and people’s ability to pay,” said John Morrow, executive vice president of iVantage.
Gifford was founded in 1903 and is part of Vermont’s non-profit health system. A 25-bed hospital in Randolph, it has eight outlying health centers meeting community members’ health needs where they live and work.
For the last 14 consecutive years, Gifford has met its state-approved budget and operating margin – a unique feat amid challenging economic times. At the same time, Gifford has embraced community health improvement initiatives that benefit patients, such the Vermont Blueprint for Health and by achieving Federally Qualified Health Center status.
A Critical Access Hospital is a hospital certified to receive cost-based reimbursement from Medicare. This program is intended to reduce hospital closures in rural areas, promotes a process for improving rural health care and focuses on community needs. Federally Qualified Health Centers are also nationally designated, but rather than inpatient care support outpatient primary care, including mental and dental health.
“What is interesting about this evaluation is that it looks at so many different indicators, all publicly available data, and combines them into a comprehensive evaluation. This year factors also grew to include the health of our community – a vital area where Gifford as a Critical Access Hospital and a Federally Qualified Health Center excels,” said Ashley Lincoln, Gifford director of development and public relations.
“These findings tell our community that we not only have a strong, high-quality local health care provider but that Gifford is well positioned for health care reform,” Lincoln added.
Springfield and Copley hospitals in Vermont also made the list.
Free health fair and diabetes expo focuses on chronic illness
Gifford chefs Ed Striebe, left, and Steve Morgan present at a past Diabetes Education Expo. The annual, free event is expanded this year to all with chronic illnesses and includes a health fair as well as presentations, including a cooking demonstration by Morgan.
Gifford Medical Center will hold a free Health Fair and Diabetes Education Expo on Friday, March 14 from 10 a.m. to 2 p.m. in the Randolph hospital’s Conference Center and visitors’ entrance.
The fair, redesigned from past years, is open to anyone with a chronic condition, not just those with diabetes. It does not require registration, and puts a strong emphasis on “Creating a Healthy Lifestyle” – the fair’s theme.
Gifford has held a Diabetes Education Expo for eight prior years. While the diabetes epidemic remains, organizers from Gifford’s Blueprint for Health team decided to expand the event this year to other conditions because so much of what is being discussed is applicable, explained Jennifer Stratton, Gifford certified diabetes educator.
“Most people who have chronic conditions have something in common,” Stratton said. “I also wanted to open it up to those with pre-diabetes to help prevent diabetes from actually happening.”
The day includes vendor booths and a health fair open throughout the 10 a.m. to 2 p.m. event. Vendor booths are located in the hospital’s visitors’ entrance south of the hospital near the Gift Shop. Vendors this year are local community resource agencies and organizations talking about services and help available locally.
Health fair booths are in one of the hospital’s conference rooms and include blood pressure checks, foot checks, glucose monitoring, goal-setting guidance and guidance on healthy lifestyle choices, physical therapy exercises, tobacco cessation help, diabetes education, information on support groups, and more. The booths are operated by experts from Gifford as well as local dentist Dr. John Westbook and local optometrist Dr. Dean Barelow.
Special presentations will also be offered in a second conference room, including a 10-10:45 a.m. talk by Stratton on “Advances in Diabetes Management;” an 11-11:30 a.m. talk on “Using Herbs to Complement Your Diabetes Wellness Plan” by Sylvia Gaboriault, a registered dietitian and certified diabetes educator; and a 1-1:30 p.m. cooking demonstration on “Sugar ‘Less’ Baking” with Gifford chef Steve Morgan.
Participants may drop in or stay all day. A couple of raffle drawings will be offered and the hospitals’ cafeteria will be open for those wishing to buy lunch.
Learn more by calling Gifford’s Blueprint team at (802) 728-7710. Gifford Medical Center is located at 44 S. Main St. (Route 12) in Randolph. Drive past the hospital, south on Route 12, and take the entrance just after the medical center to access the visitors’ entrance. The Conference Center is marked with a green awning. For handicapped accessibility, go in the main entrance marked “Registration” and take the elevator to the first floor.
Gifford’s Blueprint for Health Team has expanded to include additional mental health and addiction counselors offering one-on-one care at all Gifford primary care locations. In this file photo, from left, care coordinator Keith Marino, Health Connections (financial assistance) case worker Michele Packard and certified diabetes educator Jennifer Stratton discuss a patient at the Bethel Health Center.
In 2012 as part of the federal Patient Protection and Affordable Care Act, Gifford Medical Center completed a Community Needs Assessment.
Less than two years later, the Randolph-based medical center has already made huge strides addressing many of the needs found in that study.
In a survey of Town Meeting attendees in nine communities in 2012 plus feedback from other groups, community members’ described their priorities for a healthy community, perceived health problems and risky behaviors in the community, and their health needs or lacking services.
Among factors for a healthy community were good jobs and a healthy economy, access to health care, good schools, and healthy behaviors and lifestyles. Top health problems listed by survey respondents included addiction, obesity, and unhealthy lifestyle choices. Top health needs, or services community members have tried unsuccessfully to access, within the community were assisted living and nursing home care, alcohol and drug counseling, and dental care.
Today, Gifford is preparing to break ground in the spring on a senior living community in Randolph Center that will, over time, provide a full spectrum of housing options including the relocation of its award-winning nursing home and newly created assisted and independent living. Gifford has earned the coveted Federally Qualified Health Center (FQHC) designation, making it one of only three hospitals in the country to be both a Critical Access Hospital and an FQHC. This means expanded access to care, including dental and mental health care. And the medical center’s Vermont Blueprint for Health Team has greatly expanded over the past year to include more mental health and addiction counselors, providing services at all Gifford primary care locations.
Among Gifford’s free community services is a chronic illness support group. Here Gifford pharmacist Jane McConnell provides medication advice to past participants.
“Each of these major initiatives, which have taken substantial work, targets an identified community health need. Meeting these needs and addressing the community’s feedback defines the future of Gifford and its expanding role,” says Ashley Lincoln, director of development and public relations at Gifford.
The Community Needs Assessment process is required every three years, but Gifford’s efforts are ongoing. The medical center continually provides community outreach initiatives to meet care needs, many of which are offered for free. These include classes, support groups, and health fairs. Additionally, many initiatives support local economic health, including a buy local approach.
The medical center also continues community outreach daily through a boots-on-the-ground approach that has Blueprint Community Health Team working directly with individuals and community organizations to address health and socioeconomic needs, particularly for the chronically ill.
“The Blueprint for Health is a statewide initiative. Gifford has placed extra focus on meeting community members’ needs so they can successfully manage their health,” says Blueprint Project Manager LaRae Francis. “This approach means not waiting months or years for needs to be determined, but matching resources and needs today to create an ongoing healthier community for all.”
A grant from through the Vermont Department of Health helped support the costs of the 2012 report. The full report is available on Gifford’s website in the “About Us” section under Community Reports.
The following was published in our 2012 Annual Report.
Reflections on the past remind us of our roots and of how health care has changed in the past decades. Chief among those is the increasing role mid-level providers, such as nurse-midwives, nurse practitioners, and physician assistants, play in health care. Today, we have diverse physician-led health care teams in every area of medicine to encourage and support wellness.
Mid-level providers are extremely instrumental at birth, during hospital stays, in the primary care setting, specialty clinics, and even for our surgical patients. This team approach to care improves provider access and quality of care.
At Gifford, we are transitioning with great success to a team-based approach and are taking steps to ensure continued access to high-quality health care.
In 2012, some of those steps included new radiology services and technology, such as more interventional offerings, an upgraded 64-slice CT scanner, and a fluoroscopy room.
The midwifery team has expanded to the Twin River Health Center in White River Junction. Gifford’s approach to obstetrics and gynecology has grown to include more complicated cases.
The Blueprint Community Health Team has expanded and behavioral health is increasingly a part of Gifford’s offerings. Thanks to a generous gift from the Auxiliary, new CarePoint EKG transmission technology is available between our Emergency Department and ambulance services to identify heart attacks in the field and determine the best and fastest course of treatment.
Urology offerings have also grown and the Cancer Committee continues to expand. The Sharon Health Center sports medicine team has welcomed a nurse practitioner and second chiropractor.
These improvements are examples of the changes and quality upgrades we, as part of the health care team, can affect in an institution of the size and mindset of Gifford for the betterment of the community. Meld these improvements with Gifford’s foundation of patient care and advocacy, and we have a formula for success for decades to come.
Ovleto Ciccarelli, MD, Surgery Division
Martin Johns, MD, Hospital Division
Joshua Plavin, MD, MPH, Medicine Division
Beginning Jan. 1, federal law requires all Americans to have health insurance or face a tax penalty. Gifford has specially-trained staff called “navigators” available to help you sign-up for a health plan.
This information appeared in our Fall 2013 Update Community Newsletter.
Beginning on Jan. 1, federal law requires all Americans to have health insurance or face a tax penalty.
In the Green Mountain State, Vermont Health Connect is the new online marketplace where individuals, families and businesses with 50 or fewer employees can shop for, compare and purchase insurance plans.
Open enrollment for these plans began this October. Vermonters can determine their eligibility and enroll online. For those without computer access or needing in-person support, Gifford has resources to help.
Across the state, “navigators” have been trained and taken rigorous exams to provide one-on-one assistance with the Vermont Health Connect marketplace.
Gifford has three navigators through its Health Connections office, a part of the Vermont Coalition of Clinics for the Uninsured, as well as the medical center’s Blueprint for Health team.
A Vermonter without health insurance,
A Vermonter who currently purchases insurance yourself,
A Vermonter with Medicaid or Dr. Dynasaur,
A Vermonter with Catamount or the Vermont Health Access Program,
A Vermonter with “unaffordable” coverage provided by your employer, or
A small business with 50 or fewer people
and you need help understanding the exchange, get help by calling Gifford Health Connections at 728-2323.
Individuals who are fully enrolled by Dec. 16 will have health coverage starting Jan. 1.
Under Vermont Health Connect, an employer-sponsored plan is considered “unaffordable” if your premium for yourself is more than 9.5 percent of your household income. To learn more, call (855) 899-9600 or visit www.healthconnect.vermont.gov.
The following was featured in our 2012 Annual Report.
Our effectiveness as a medical home has grown this year with the expansion of health care teams and our collaboration with the Vermont Blueprint for Health. But at the heart of these teams are Gifford’s long-established primary care practices. In each of our health team locations, we have providers and support staff whose relationships with the community run deep.
Take Starr Strong, for example. For 19 years, Starr has committed herself to the people of Chelsea – first under the mentorship of Dr. Brewster Martin and now as a mentor in her own right.
With humility and compassion, family physician Dr. Ken Borie has cared for the people of Randolph for 32 years. The humanity he brings to medicine is an example for all, including the many medical students who he guides through the family medicine portion of their clinical studies.
And Dr. Lou DiNicola, a local pediatrician for 36 years, has been among the foremost leaders in this state when it comes to children, advocating at every turn for their health, safety, and welfare.
Those of us enjoying long-standing relationships with Gifford and with our central Vermont community consider ourselves fortunate to know and work with these practitioners and their support teams. Such stability, and depth, builds our medical homes into more effective tools for helping our patients.
~ Marcus Coxon
Medical Staff President & family physician
Born in New Jersey, Dr. Lou DiNicola moved to Randolph in June of 1976 to become a local pediatrician. Passing up job offers in much larger areas then and since, he chose to stay in Randolph because he’s been able to able to practice medicine as he always envisioned. He has been able to affect change on a state level; create unique, trend-setting models of health care; and demonstrate his love of the community through his work.
Married to his wife Joann for 43 years, the couple has two grown children, two grandchildren, and a third on the way. Dr. DiNicola is an outdoor enthusiast, enjoying hiking, snowshoeing, walking, and gardening. He’s also a photographer and works with his artist wife, framing her paintings.
Dr. DiNicola has spent his entire career in Randolph while also working in Rochester from 1977-1992 with internal medicine physicians Drs. Mark Jewett and Milt Fowler.
Below is his story as told in his own words, as featured in our 2012 Annual Report.
Thirty-six years ago I was fresh out of residency and looking for job opportunities when I saw an ad in a magazine for a pediatrician in rural Vermont. Vermont was where I wanted to work, so I sent in my curriculum vitae, the medical equivalent of a resume, but never heard a word back. I called but the response was less than enthusiastic. I was basically told “thanks, but no thanks.”
I had three job offers in Pittsburgh and was literally sitting down to take a job at Children’s Hospital of Pittsburgh where I’d just completed my internship and residency when my pager went off. It was Gifford President Phil Levesque’s secretary, wondering if I could come up in a couple of weeks for an interview. “I’ll come this weekend, or I’m not coming at all” was my response. The secretary covered the phone, relaying my message to Phil. “Hell, let him come” was his reply.
Needless to say, I came, and stayed.
More than three decades later I hope I have made a positive impact on the community and my patients, and know they have made a remarkable impact on me – teaching me how to communicate care, respect, and love.
It’s amazing how much you can love your patients. Also amazing is the window being a pediatrician gives you to see the love between a parent and a child. No more clearly is that demonstrated than in the unconditional love between a parent and a special needs child. More than once, parents of special needs children have amazed me and inspired me, as have the children themselves. I’ve seen parents of special needs children go on to adopt more children with special needs. Those are the moments that touch you most; those, and loss.
Dr. DiNicola thumb wrestles with patient Troy Daniels.
There is no greater loss than the loss of a child. Throughout my career, there have been car accidents, disease, malignancies, and newborn deaths. I think of two patients I lost to cancer, both of whom I visited at their bedsides at home as they were dying. As I reflect on my career, I think of them not with tears but fondness because of the relationships I have had with their families.
At Gifford, we are small enough to have that closeness with our patients and courageous enough to get up the next day and reflect on what we did or didn’t do, what we could have done differently, and how we can improve care. This ability to affect change is one of the things that has kept me practicing – happily – in this community and state for so many years.
One of the biggest changes Gifford has been able to enact in health care is around childbirth. When I first came to Gifford, I kept hearing about this guy Thurmond Knight, a local physician who was delivering babies in people’s homes. I met Thurmond at a Medical Staff meeting. He was knitting. I asked him what it would take for him to deliver babies at the hospital. He answered “a Birthing Center”. We opened the Birthing Center (the first in the state of Vermont) 35 years ago in 1977.
I’ve also been fortunate to be part of and help form organizations that were decades ahead of their time, in many ways laying the foundation for today’s medical home and Vermont Blueprint for Health models as well as utilizing computers for communication at the advent of the computer revolution. Additionally, Vermont has provided me with the opportunity to work on important legislation, such as child abuse laws, outlawing corporal punishment in schools, mandatory kindergarten, and the recent immunization law. These opportunities along with the privilege of making a difference in kids’ and families’ lives keep me going.
One of the things I find incredibly rewarding is living and working in the same town. I don’t mind if I run into someone downtown and they ask me a question. And I feel it’s so important that we recognize and talk to kids. One way I have been able to successfully converse and care for kids for so long is through humor. I try to infuse that in my appointments with children and often am treated – sometimes at unexpected moments – to humor in return.
One such humorous moment came from a 5-year-old. I try to end all my appointments by asking if patients have any questions for me. This 5-year-old’s question: “Why do frogs jump so high?” Should I ever write a book, I think this will be the title.
~ Lou DiNicola, M.D.
Above left – Dr. DiNicola in 1979. Above right – Dr. DiNicola with Kim Daniels of Berlin and her adopted son Troy. Troy along with his siblings, Maggie, Ben, and Alex, were patients of Dr. DiNicola’s for years. Dr. DiNicola credits Kim, who had a special needs child and then adopted two more, with showing him the true meaning of love and parenting. Troy credits Dr. DiNicola with seeing him as a person.